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Team Management Techniques

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					                                                                      NC DHHS
   Reviewer:
                                                                   DMH/DD/SAS
   Date Reviewed:                                  Community Support (MH/SA)- Children/ Adolescents
                                                            Conditional                       Full
                        DESCRIPTION                        Endorsement                   Endorsement
           COMMUNITY SUPPORT (MH/SA) -                      Evidence of      NOT          Evidence of               NOT
             CHILDREN/ADOLESCENTS                           Compliance MET   MET   NA     Compliance          MET   MET   NA   COMMENTS
   Provider Requirements
a. **1) Must be delivered by practitioners employed by
  a mhsa provider organization which meets
  standards established by the Division of                     Provider
                                                                                            Provider
  MHDDSAS. These standards set forth the                      application
                                                                                         application with
  administrative, financial, clinical, quality                   with all
                                                                                           all required
  improvement, and information services                         required
                                                                                           supporting
  infrastructure necessary to provider services.              supporting
                                                                                         documentation
   2) Organizations must demonstrate that they meet         documentation
                                                                                          completed as
  these standards by being certified by the LME. Within 3 completed as
                                                                                           required in
  years of enrollment, must have national accreditation       required in
                                                                                            provider
                                                                provider
                                                                                           application;
  ** 3) The organization must be established as a             application;
                                                                                            Program
  legally recognized entity in the US and registered to        Program
                                                                                           description;
  do business as a corporate entity in the State of           description;
                                                                                            Policy &
  N.C.                                                          Policy &
                                                                                           Procedure
  4) CS providers must have the ability to deliver services   Procedure
                                                                                             Manual
  in various environments, such as homes, schools,               Manual
  detention centers & jails (state funds only) homeless
  shelters, street locations, etc.
b There is evidence of fidelity to EBP                       training plan               training records
   Staffing Requirements
a **1) Persons who meet the requirements specified                                       Personnel files;
   for Qualified Professional or Associate Professional                                     Supervision
   status according to 10A NCAC 27.G.0104, within                                            plans and
   the requirements specified in the above rule. 2)                                       documentation
                                                              Program
   Supervision is provided according to supervision                                       that education,
                                                            description;
   requirements specified in 10A NCAC 27.G.0104 &                                          experience &
                                                             Personnel
   according to licensure or certification requirements                                  training for staff
                                                            Manual; Job
   of the appropriate discipline.                                                          are consistent
                                                            descriptions
                                                                                                with
                                                                                           requirements
                                                                                                and
                                                                                         responsibilities.




                                                                               1 of 13                                         d5e286e8-5eef-4520-ada5-912166fe1c45.xls
                                                                         NC DHHS
    Reviewer:
                                                                      DMH/DD/SAS
    Date Reviewed:                                    Community Support (MH/SA)- Children/ Adolescents
                                                                 Conditional                        Full
                         DESCRIPTION                            Endorsement                    Endorsement
           COMMUNITY SUPPORT (MH/SA) -                           Evidence of      NOT           Evidence of             NOT
              CHILDREN/ADOLESCENTS                               Compliance MET   MET   NA      Compliance        MET   MET   NA   COMMENTS
  Staffing Requirements (continued)
b **1) Paraprofessional level providers who meet the
  requirements specified for paraprofessional status
  according to 10A NCAC 27.G.0104 N.C. may deliver
  CS services within the requirements of the staff                                             Personnel files;
  definition specific in the above role. **2) When a              Program                        Supervision
  paraprofessional provides CS services they must               description;                      plans and
  be under the supervision of a QP. Supervision                  Personnel                      documentation
  shall be carried out according to 10A NCAC                    Manual; Job                    that supervision
  27.G.0104.                                                    descriptions                  requirements are
   **2) When a paraprofessional provides CS                                                       being met.
  services they must be under the supervision of a
  QP. Supervision shall be carried out according to
  10A NCAC 27.G.0104.
c QP, CCS, CCAS can perform the following activities:             Program                     Personnel files
  Coordination & oversight of initial & ongoing                 description;                   and consumer
  assessment activities; initial development & ongoing           Personnel                     charts to show
  revision of PCP; monitoring of implementation of PCP.         Manual; Job                     QP actions re
                                                                descriptions                          PCP
d AP and paraprofessional can perform the following               Program                     Personnel files
    activities: various skill building activities of daily &    description;                   and consumer
    community living skills; socialization skills, adaptation    Personnel                     charts to show
    skills; symptom management skills, wellness education;      Manual; Job                     AP and Para-
    education substance abuse; behavior & anger                 descriptions                    prof activities
    management techniques.                                                                          with/for
                                                                                                 consuumer.
e    Staff providing CS services to children & families must      Program                     Personnel files
    complete a twenty hours of training specific to CS          description;                     showing that
    including crisis response within the first 90 days of        Personnel                       staff have at
    employment.                                                 Manual; Job                    least minimum
                                                                descriptions                  experience and
                                                                                              documentation
                                                                                              of completion of
                                                                                                    training
                                                                                                requirements.




                                                                                    2 of 13                                        d5e286e8-5eef-4520-ada5-912166fe1c45.xls
                                                                         NC DHHS
    Reviewer:
                                                                      DMH/DD/SAS
    Date Reviewed:                                    Community Support (MH/SA)- Children/ Adolescents
                                                                 Conditional                        Full
                         DESCRIPTION                            Endorsement                    Endorsement
            COMMUNITY SUPPORT (MH/SA) -                          Evidence of      NOT           Evidence of           NOT
              CHILDREN/ADOLESCENTS                               Compliance MET   MET   NA      Compliance      MET   MET   NA   COMMENTS
  Service Type / Setting
a CS is a direct & indirect periodic service where the CS
   worker provides direct intervention & also arrange,                                        Program
   coordinates, & monitors services on behalf of the            Program                       description,
   recipient. Service is provided in any location and may       description                   PCP, service
   be provided to an individual or a group of individuals.                                    notes

b 1) For persons residing in higher-level residential           Program                       Program
   program (e.g., PRTF, residential levels II-IV), CS           description                   description,
   services are limited to individuals transitioning from or to                               PCP, service
   these residential programs.                                                                notes, Medicaid
                                                                                              RA forms
c 1) CS also includes telephone time with the recipient & Program                             PCP, service
   collateral contact with persons who assist the recipient     description                   notes, Medicaid
   in meeting his/her rehabilitation goals.                                                   RA statements
  Program/Clinical Requirements
a All youth receiving CS must receive a minimum of two          program                       PCP, service
  (2) contacts per month with one (1) contact occurring         description                   notes, billing
  face-to-face with the recipient.                                                            tracking forms
b Contact benchmarks shall be measured on an annual             program                       Annual
  basis substantiating sixty per cent (60%) or more of CS       description                   aggregate
  services are delivered face-to-face with recipients &                                       provider report
  sixty per cent (60%) or more of staff time must be spent
  working outside of the agency's facility, with or on behalf
  of the consumers.
c 1) Caseload size may not exceed 1:15 (one QP worker           program                       staff caseload
  per fifteen (15) clients. 2) Groups size may not exceed       description                   assignment,
  eight (8) individuals.                                                                      group
                                                                                              attendance
                                                                                              roster




                                                                                    3 of 13                                      d5e286e8-5eef-4520-ada5-912166fe1c45.xls
                                                                   NC DHHS
   Reviewer:
                                                                DMH/DD/SAS
   Date Reviewed:                               Community Support (MH/SA)- Children/ Adolescents
                                                         Conditional                        Full
                       DESCRIPTION                      Endorsement                    Endorsement
          COMMUNITY SUPPORT (MH/SA) -                    Evidence of      NOT           Evidence of             NOT
            CHILDREN/ADOLESCENTS                         Compliance MET   MET   NA      Compliance        MET   MET   NA   COMMENTS
  Program/Clinical Requirements (continued)
d **The development, monitoring, revising and           Policies and                  Policies and
  updating of the recipient's person centered plan is   Procedures in                 Procedures in
  the responsibility of the qualified professional      place for PCP                 place for PCP
                                                        development                   development.
                                                        that includes                 PCP in chart.
                                                        crisis planning               Documentation
                                                        and procedure                 of C&F Team
                                                        for involvement               meetings, with
                                                        of child and                  membership,
                                                        family team.                  roles,
                                                                                      responsibilities.
                                                                                      Documentation
                                                                                      of family
                                                                                      involvement.




                                                                            4 of 13                                        d5e286e8-5eef-4520-ada5-912166fe1c45.xls
                                                                       NC DHHS
    Reviewer:
                                                                    DMH/DD/SAS
    Date Reviewed:                                  Community Support (MH/SA)- Children/ Adolescents
                                                              Conditional                          Full
                         DESCRIPTION                         Endorsement                     Endorsement
            COMMUNITY SUPPORT (MH/SA) -                       Evidence of      NOT            Evidence of      NOT
               CHILDREN/ADOLESCENTS                           Compliance MET   MET   NA       Compliance MET   MET   NA   COMMENTS
e   **The Community Support must have policies and          Policies and                   Policies and
    capacity to carry out "first responder"                 procedutes in                  procedures in
    responsibilities for their recipients on a face to face place for crisis               place for crisis
    basis and also telephonically at all times (24/7/365), response                        response. Crisis
    with capacity for face-to-face emergency response implementation                       Plans in charts.
    within 2 hours.                                         including on                   Proactive Plan
                                                            call scheduling                with triggers and
                                                            process;                       Reactive Plane
                                                            process for the                with contacts
                                                            on call person                 and phone
                                                            to have access                 numbers;
                                                            to consumer's                  Service notes
                                                            crisis plan that               document
                                                            includes                       implementation
                                                            proactive plan                 of crisis plan
                                                            with triggers                  when needed.
                                                            and reactive                   On call rotation
                                                            plan with                      schedule. On
                                                            contacts &                     call person has
                                                            phone                          access to and
                                                            numbers and                    follows
                                                            procedures to                  consumer's crisis
                                                            ensure that                    plan.
                                                            crisis plan is
                                                            followed by
                                                            provider.


    Documentation Requirements
    Minimum standard is a daily full service note that      Service record;                PCP; service
    includes: 1) the purpose of contact, 2) describes the   Policy &                       notes document
    provider's interventions, 3) effectiveness of the       Procedure                      these items.
    intervention, 4) the time spent performing the          Manual
    intervention, and 5) signature (degree/credentials or
    position) of person providing service




                                                                                 5 of 13                                  d5e286e8-5eef-4520-ada5-912166fe1c45.xls
Reviewer:                                                      NC DHHS                                                 Provider:_________________
Date Reviewed:                                                DMH/DD/SAS                                              Site:______________________

                                                Community Support Team (CST-MH/SA Adults)
                               DESCRIPTION
                                                                                                                     60-day review
              Community Support Team (MH/SA) CST                        Evidence of Compliance              NOT       Evidence of
                                                                                                        MET MET NA    Compliance      COMMENTS
      Provider Requirements
  a   1) Agency has current, valid business verification.               NEA from another LME or
                                                                         Business Verification
                                                                           completed locally
      Staffing Requirements
  a   CST shall be comprised of three full-time staff positions as
      follows:
      • one full-time team leader who is a master’s-level Qualified   Organizational Chart for CST;
      Professional, a Provisionally Licensed Professional, or a          Program description; Job
      Licensed Professional                                             description consistent with
      AND                                                            Provider Agency Policy for CST
      • one full-time equivalent (FTE) Qualified Professional (may be service definition; Personnel
      filled by no more than two individuals)                         files per core rules checklist;
      AND                                                                 License/certification (if
      • one FTE Qualified Professional, Associate Professional,           applicable); experience
      Paraprofessional, or Certified Peer Support Specialist.           verification; staff schedule;
                                                                             Clinical Interviews
  b
                                                                 Organizational Chart for CST;
                                                                    Program description; Job
                                                                   description consistent with
                                                                Provider Agency Policy for CST
                                                                 service definition; Personnel
                                                                 files per core rules checklist;
                                                                     License/certification (if
                                                                     applicable); experience
      Persons who meet the requirements specified for QP or AP     verification; Individualized
      status according to 10A NCAC 27G. 0104 and a minimum of 1    Supervision Plan/Contract;
      year of documented experience with the adult MH/SA             staff schedule; Clinical
      population may deliver CST                                             Interviews




CST 9-23-09...... DRAFT                                                  Page 6                                                      NC DMH/DD/SAS
Reviewer:                                                      NC DHHS                                                     Provider:_________________
Date Reviewed:                                                DMH/DD/SAS                                                  Site:______________________

                                                Community Support Team (CST-MH/SA Adults)
                               DESCRIPTION
                                                                                                                         60-day review
              Community Support Team (MH/SA) CST                           Evidence of Compliance               NOT       Evidence of
                                                                                                            MET MET NA    Compliance      COMMENTS
  c A Paraprofessional level staff may be part of the 3 person
      team. They must meet the requirements specified for                 Organizational Chart for CST;
      paraprofessional status according to 10A NCAC 27.G.0104                Program description; Job
      and have a minimum of 1 year of documented experience with            description consistent with
      the adult MH/SA population and may deliver CST services            Provider Agency Policy for CST
      within the requirements of the staff definition specific in the     service definition; Personnel
      above role.                                                         files per core rules checklist;
                                                                              License/certification (if
                                                                              applicable); experience
                                                                            verification; Individualized
                                                                            Supervision Plan/Contract;
                                                                              staff schedule; Clinical
                                                                                      Interviews
  d   A Certified Peer Support Specialist staff may be part of the 3
      person team and may deliver CST services within the                 Organizational Chart for CST;
      requirements of the staff definition specific in the above role. A     Program description; Job
      Certified Peer Support Specialist is not required to                  description consistent with
      demonstrate 1 year of documented experience in working with Provider Agency Policy for CST
      the adult MH/SA population, as his or her personal experience service definition; Personnel
      in MH/SA services fulfills that requirement.                        files per core rules checklist;
                                                                              License/certification (if
                                                                              applicable); experience
                                                                            verification; Individualized
                                                                            Supervision Plan/Contract;
                                                                              staff schedule; Clinical
                                                                                      Interviews




CST 9-23-09...... DRAFT                                                     Page 7                                                       NC DMH/DD/SAS
Reviewer:                                                       NC DHHS                                                        Provider:_________________
Date Reviewed:                                                 DMH/DD/SAS                                                     Site:______________________

                                                 Community Support Team (CST-MH/SA Adults)
                               DESCRIPTION
                                                                                                                            60-day review
              Community Support Team (MH/SA) CST                           Evidence of Compliance                NOT         Evidence of
                                                                                                             MET MET NA      Compliance       COMMENTS
  e Individualized Supervision is provided according to supervision
      requirements specified in 10 A NAC27.G.0104 & .0203 and is          Organizational Chart for CST;
      provided by CST Team Leader.                                            Program description; Job
                                                                             description consistent with
                                                                         Provider Agency Policy for CST
                                                                           service definition; Personnel
                                                                           files per core rules checklist;
                                                                               License/certification (if
                                                                               applicable); experience
                                                                             verification; Individualized
                                                                             Supervision Plan/Contract;
                                                                               staff schedule; Clinical
                                                                                        Interviews
  f   The CST maintains a maximum caseload of 45 individuals per Program description; Personnel
      team. The recipient-to-staff ratio is no more than 15:1. The             Manual; Job description                    caseload list;
      team caseload will be determined by the level of acuity and the consistent with Provider Agency                     billing/tracking
      needs of the individuals served.                                         Policy for CST service                     forms; service
                                                                                        definition.                       notes
  g   All CST staff must complete a minimum of 20 hours of training
                                                                         Program description; Personnel
      specific to the required components of the CST service
                                                                              Manual; Job descriptions.
      definition, including crisis response and person-centered
                                                                            Personnel files and/or other
      thinking, within the first 90 days of each staff member’s
                                                                             documentation of required
      delivery of this service. Qualified Professional staff responsible
                                                                          experience and completion of
      for Person Centered Plan development shall also participate in
                                                                          training requirements per core
      “PCP Instructional Elements” training within the same time
                                                                               rules checklist; training
      frame. All pre-requisites for training have been met per 10A
                                                                              certificates. Agency staff
      NCAC 27G .0202 & .0203.
                                                                                      training plan

      Service Type/Setting




CST 9-23-09...... DRAFT                                                      Page 8                                                          NC DMH/DD/SAS
Reviewer:                                                       NC DHHS                                                Provider:_________________
Date Reviewed:                                                 DMH/DD/SAS                                             Site:______________________

                                                 Community Support Team (CST-MH/SA Adults)
                               DESCRIPTION
                                                                                                                    60-day review
              Community Support Team (MH/SA) CST                            Evidence of Compliance       NOT         Evidence of
                                                                                                     MET MET NA      Compliance        COMMENTS
  a 1) CST is a direct and indirect periodic rehabilitative service in
      which the team provides medically necessary direct
      intervention and also arranges, coordinates, & monitors
      services on behalf of the recipient & and is provided in any
      location. CST providers shall deliver services in various
                                                                      Program description; job
      environments, such as homes, schools, courts, homeless
                                                                      descriptions; policy and
      shelters, street locations, libraries, vocational settings, and
                                                                      procedure manuals;
      other community settings. 2) CST also includes telephone time
      with the recipient and collateral contact with persons who
      assist the recipient in meeting their rehabilitation goals                                                  PCP, service
      specified in the Person Centered Plan.                                                                      notes, Medicaid
                                                                                                                  RA forms
      Program / Clinical Requirements
  a   CST shall provide at least eight (8) contacts in the first month    Program description; job
      of service. In subsequent months, CST services are provided         descriptions; policy and                PCP; service
      at least once a week.                                               procedure manuals;                      notes; billing
                                                                          supervision plans; Team                 tracking forms;
                                                                          Meeting Minutes                         client interviews
  b 1) Seventy-five per cent (75%) or more of CST services that           Program description; job
      are delivered are performed face to face with recipients, 2)
                                                                          descriptions; policy and
      Seventy-five per cent (75%) or more of staff time must be
                                                                          procedure manuals;
      spent working outside of the agency's facility, with or on behalf                                           Service Notes;
                                                                          supervision plans; Team
      of consumers. 3) CST Team Leader actively participates in                                                   PCP; Team
                                                                          Meeting Minutes
      the delivery of the service.                                                                                meeting minutes.




CST 9-23-09...... DRAFT                                                       Page 9                                                  NC DMH/DD/SAS
Reviewer:                                                        NC DHHS                                                Provider:_________________
Date Reviewed:                                                  DMH/DD/SAS                                             Site:______________________

                                                  Community Support Team (CST-MH/SA Adults)
                               DESCRIPTION
                                                                                                                      60-day review
              Community Support Team (MH/SA) CST                              Evidence of Compliance       NOT         Evidence of
                                                                                                       MET MET NA      Compliance      COMMENTS
  c The members of the team collaborate to provide services and
     interventions documented in a Person Centered Plan, which
     shall include the following, as clinically indicated:
     • identification of strengths that will aid the individual in his or
     her recovery, as well as the identification of barriers that
     impede the development of skills necessary for independent
     functioning in the community;
     • individual and team therapeutic interventions with the
     recipient that directly increase the acquisition of skills needed
     to accomplish the goals of the Person Centered Plan;
     • psychoeducation regarding 1) the identification and self-
     management of the prescribed medication regimen, with
     documented communication to prescribing practitioner(s), 2)
     the identification and self-management of symptoms, as well
                                                                            Program description; job
     as the identification and self-management of triggers and
                                                                            descriptions; policy and
     cues (early warning signs); direct preventive and therapeutic
                                                                            procedure manuals;
     interventions that will assist with skill building related to goals
                                                                            supervision plans, Team
     in the Person Centered Plan, 3) and training of family, unpaid
                                                                            Meeting Minutes
     caregivers, and others who have a legitimate role in
     addressing the needs identified in the Person Centered Plan;
     • coordination and oversight of initial and ongoing assessment
     activities; ensuring linkage to the most clinically appropriate
     and effective services;
     • facilitation of the person centered planning process, which
     includes the active involvement of the recipient and people
     identified as important to him or her (such as family, friends,
     and providers);
     • effective coordination of clinical services, natural supports,
     and community supports for the recipient and his or her family.
                                                                                                                    PCP; service
                                                                                                                    notes; client
                                                                                                                    interviews
     Program/Clinical Requirements(continued)

CST 9-23-09...... DRAFT                                                        Page 10                                                NC DMH/DD/SAS
Reviewer:                                                        NC DHHS                                                       Provider:_________________
Date Reviewed:                                                  DMH/DD/SAS                                                    Site:______________________

                                                  Community Support Team (CST-MH/SA Adults)
                               DESCRIPTION
                                                                                                                             60-day review
              Community Support Team (MH/SA) CST                            Evidence of Compliance                NOT         Evidence of
                                                                                                              MET MET NA      Compliance        COMMENTS
  d CST Team Leader drives the delivery of this rehabilitation
      service. In partnership with the recipient, the assigned CST                                                         PCP in chart.
      Qualified Professional identified as the person responsible for                                                      Documentation of
      the Person Centered Plan has ongoing clinical responsibility                                                         PC Planning
      for the initial development, implementation, monitoring, and                                                         meetings, with
      ongoing revision of the Person Centered Plan including                                                               consumer
      involving other medical and non-medical providers and natural                                                        participation and
      and community supports. The CST Team Leader is                                                                       input into all
      responsible for monitoring and evaluating the effectiveness of                                                       decisions. Service
      interventions as evidenced by symptom reduction and                  Policies and Procedures in                      notes document
      progress toward goals identified in the Person Centered Plan place for PCP development.                              implementation of
      for all reciepients the team serves.                                 Team Meeting minutes;                           plan consistent
                                                                           Program description; job                        with PCP. Team
                                                                           descriptions; supervision plans;                meeting minutes
      Program/Clinical Requirements(continued)
  e   The agency must have has policies in place specifying CST
      staff responsibility to carry out first responder activities for the
      recipients the team serves. First responder activities include
      face to face and telephonically, and are available at all times
      (24/7/365), with capacity for face-to-face emergency response
      within 2 hours. Each recipient’s crisis plan is included in their
      Person Centered Plan. The CST staff must provide direct                                                               Crisis Plan is
      interventions in escalating situations to prevent a crisis                                                           completed in
      (including identifying cues and triggers). CST staff also provide                                                    compliance with
      assistance to the recipient and his or her natural supports in       Program description, policy                     PCP Instruction
      implementing preventive and therapeutic interventions outlined and procedure manuals, job                            Manual. Service
      in the Person Centered Plan (including the crisis plan).                                                             notes document
                                                                         descriptions, supervision                         implementation of
                                                                         plans, team meeting minutes,                      crisis plan when
                                                                         on-call schedule                                  needed.




CST 9-23-09...... DRAFT                                                      Page 11                                                           NC DMH/DD/SAS
Reviewer:                                                      NC DHHS                                                       Provider:_________________
Date Reviewed:                                                DMH/DD/SAS                                                    Site:______________________

                                                Community Support Team (CST-MH/SA Adults)
                              DESCRIPTION
                                                                                                                          60-day review
             Community Support Team (MH/SA) CST                            Evidence of Compliance              NOT         Evidence of
                                                                                                           MET MET NA      Compliance         COMMENTS
  f CST is an intensive community-based rehabilitation team
     service that provides treatment and restorative interventions
     carried out by the team and designed to meet the following
     outcomes:
     • assist the recipient in achieving recovery goals identified in
     the Person Centered Plan;
     • reduce psychiatric and addiction symptoms and promote
     symptom stability;
     • restore personal, community living, and social skills
     necessary for self-management;
     • assist individuals to gain access to necessary services in all
     life domains;
     • increase the ability to access financial entitlement, housing,
     work, and social opportunities in the community; and
     • monitor and evaluate the effectiveness of delivery of all        Policies and Procedures in place
     services and supports identified in the Person Centered Plan.      for PCP development. ; Team
                                                                        Meeting Minutes; Program                        Staff/Client
                                                                        description; job descriptions;                  Interviews; PCP;
                                                                        supervision plans                               Service Notes
  g Signed Order based on individualized assessment.
                                                                                                                        Comprehensive
                                                                                                                        Clinical Assessment
                                                                                                                        or D/A; PCP signed
                                                                                                                        order
     Documentation Requirements




CST 9-23-09...... DRAFT                                                     Page 12                                                        NC DMH/DD/SAS
Reviewer:                                                     NC DHHS                                                     Provider:_________________
Date Reviewed:                                               DMH/DD/SAS                                                  Site:______________________

                                               Community Support Team (CST-MH/SA Adults)
                              DESCRIPTION
                                                                                                                       60-day review
             Community Support Team (MH/SA) CST                          Evidence of Compliance              NOT        Evidence of
                                                                                                         MET MET NA     Compliance      COMMENTS
     Full service note for each contact or intervention (such as
     individual counseling, case management, crisis response), for
     each date of service, written and signed by the person(s) who
     provided the service, that includes the following:
     • Recipient’s name
     • Medicaid identification number
     • Service provided (for example, CST)
     • Date of service
     • Place of service                                                  Program Description; Policy &
     • Type of contact (face-to-face, telephone call, collateral)        Procedure Manual, job
     • Purpose of the contact                                            descriptions.
     • Description of the provider’s interventions
     • Amount of time spent performing the interventions
     • Description of the effectiveness of the interventions
     • Signature and credentials of the staff member(s) providing
     the service (for paraprofessionals, position is required in lieu of
     credentials with staff signature)
                                                                                                                      PCP; service
                                                                                                                      notes




CST 9-23-09...... DRAFT                                                   Page 13                                                      NC DMH/DD/SAS

				
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Description: Team Management Techniques document sample